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Medically Compromised Patient Care

Course Number: 628

Anticoagulant Disorders

Hemophilia is a rare, inherited bleeding disorder where blood doesn’t clot normally. The symptoms include increased or prolonged bleeding (e.g., gums, nosebleeds, circumcision, menstrual periods, cuts or surgeries, and blood in stools or urine). Patients may also experience bleeding into the joints and subsequent pain and swelling, called arthropathy.

There are two main types of Hemophilia, which are A & B. Hemophilia A is the most common type and can be mild, moderate or severe. It is a result of a lack of blood clotting factor VIII and usually occurs in males. However, women can be carriers. Hemophilia B is due to the lack of blood clotting factor IX and is referred to as “Christmas disease”14, because the first person diagnosed with the disease was named Stephen Christmas in 1952. In addition, the first report of its identification was found in the Christmas edition of the British Medical Journal.

Patients with mild to moderate hemophilia are generally safe to treat. It is important to treat acute oral infection in these patients and to help them establish good oral hygiene practices. However, a medical consult is required for patients with severe hemophilia. Patients with severe hemophilia are usually treated in the hospital setting with platelet infusions or drugs to decrease bleeding. If a patient presents to the dental office with hemophilia, there are several follow-up questions to ask in order to understand the type and severity of disease (Table 9).

Table 9. Follow-Up Questions for Suspected Hemophilia Patients (1)
  • What kind of bleeding problem do you have?
  • Do you know the cause?
  • Have you had any bleeding problems following dental or medical treatment? If so, describe them.
  • How do you control bleeding problems?
  • Has your physician warned you about having dental procedures?